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CHHS18/070

Canberra Hospital and Health ServicesClinical ProcedureClinical HandoverContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – All Clinical Handovers.............................................................................................2

Section 2 – Verbal Handovers using ISBAR................................................................................4

Section 3 – Written Handover and Documentation..................................................................5

Implementation........................................................................................................................ 6

Related Policies, Procedures, Guidelines and Legislation.........................................................6

References................................................................................................................................ 7

Definition of Terms...................................................................................................................7

Search Terms............................................................................................................................ 8

Attachments..............................................................................................................................8

Attachment 1: Situations for Clinical Handover....................................................................9

Attachment 2: Examples of CHHS handover formats to General Practitioners and Community Services............................................................................................................10

Attachment 3: ISBAR for Verbal Handover..........................................................................11

Attachment 4: Example of ward handover sheet in ISBAR format......................................12

Attachment 5: ISBAR for Telephone Handover...................................................................13

Attachment 6: ISBAR example for receiving or providing clinical investigation results via the phone............................................................................................................................14

Attachment 7: Example components of written documentation using ISOAP from the Community Care Program...................................................................................................15

Doc Number Version Issued Review Date Area Responsible PageCHHS18/070 1 27/02/2018 01/03/2022 QGR - CSQU 1 of 16

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS18/070

Purpose

The purpose of this procedure is to have a standardised clinical handover process in place to facilitate timely, relevant and structured transfer of information regarding a consumer’s care between health care clinicians to enhance the continuity of care and optimise consumer safety.

This will facilitate:1. Consistency in clinical handover with essential information;2. Consumer safety; and3. Maintenance of and compliance with current best practice standards.

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Scope

This procedure applies to all ACT Health staff and students involved in and responsible for consumer care and the transfer of accountability for a consumer’s care from one person to another, this includes both direct and indirect care.


Section 1 – All Clinical Handovers

Clinical Handover refers to the transfer of information, professional responsibility and accountability for some or all aspects of care for a consumer, or group of consumers, to another person or professional group on a temporary or permanent basis. See attachment 1 for a guideline of situations for clinical handover.

At each point of handover during the consumer journey: Use the consumer record to cross-check information, using the three unique identifiers

as per CHHS Patient Identification and Procedure Matching Policy and Procedure. Communicate all important findings or changes of condition/care, including reference to

medication, infection status and relevant precautions, all clinical risks including falls and pressure injury and risk of deterioration and estimated date of discharge.

Ensure clinician receiving handover understands and accepts the handover. Ensure, where relevant a multidisciplinary approach is taken. Ensure, where possible, that consumers and carers are included in handover

discussions. Ensure accountability and responsibility for consumer care is assigned and understood. Document in the clinical record when handover of care has occurred.



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All clinical areas/divisions Must have in place mechanisms to detail their local processes for handover that adhere to this procedure (such Clinical Handover in MHJHADS Procedure). These include: Mechanisms to include consumers and carers in clinical handover processes related to

their care, for example, incorporate bedside handover. Handover tools and procedures are relevant to the type of handover occurring. Documented processes for handover are in place and include, but are not limited to:

o Ensuring all relevant staff are present, organised, educated and prepared for handover.

o Ensuring process are in place for transfer of responsibility (for example, to another health care team or shift to shift handover).

o Instances during the consumer journey where handover occurs (for example, ward clinical staff to Medical Imaging clinical staff).

Established internal processes and resources to utilise the ISBAR (Introduction, Situation, Background, Assessment, Recommendation/Read back) or ISOAP (Identification, Subjective information, Objective information, Analysis/ Action/ Advice, Plan) tool (see section 2 and 3), for example: o Referral forms which incorporate the ISOAP tool as headings.o Tools to support telephone handovers.o Ward lists which incorporate ISBAR (See Attachment 1).o Prompt sheets for staff use during verbal handover.o Electronic templates for written handover or discharge which incorporate ISOAP.

Documented organisational procedures for escalation of critical incidents involving clinical handover.

Clinical handovers can vary depending on consumer circumstance; points of handover include but are not limited to: during a shift change when consumers are transferred within a health facility and/or between health facilities during admission, referral or discharge clinician to clinician between disciplines between teams.

Methods of handover can include: face-to-face telephone or telehealth clinical documentation written orders including discharge summaries outpatient letters (e.g. by Medical Officers, Allied Health, Nurse Practitioners, etc.) electronic handover tools including e-Referrals.



CHHS18/070

The following examples, including CHHS handover formats to General Practitioners and community based services, have been included as attachments: Attachment 2: Examples of CHHS handover formats to General Practitioners and

Community Services Attachment 3: ISBAR for Verbal Handover Attachment 4: Example of ward handover sheet in ISBAR format Attachment 5: ISBAR for Telephone Handover Attachment 6: ISBAR example for receiving or providing clinical investigation results via

the phone Attachment 7: Example components of written documentation using ISOAP from the

Community Care Program

Clinical Handover in the inpatient hospital setting Clinical Handovers in hospital settings will occur at the consumer’s bedside where possible. Opportunity should be provided at each handover for consumers/carers to be involved. The involvement of carers or visitors in handover can only occur following consent from the consumer.

Whilst it is preferable that handover occur at the consumer’s bedside, handover may take place elsewhere, such as: in a common staff only area at a hospital

Alert: Staff must be aware of maintaining consumer privacy in common areas and multi bed rooms and should seek agreement from the consumer to proceed with the handover of their information.

Handover in the ambulatory or community setting All clinical handovers in the community setting either written, verbal or via e-referral are required to comply with the Patient Identification and Procedure Matching Policy and Procedure and the principles of handover using ISBAR or ISOAP.


Section 2 – Verbal Handovers using ISBAR

Verbal HandoversAll verbal handovers will use the ISBAR (introduction, situation, background, assessment, recommendation/read back) method of handover. This ensures that handover includes the following information at a minimum in the handover process.

Note: ISBAR refers to the minimum amount of information that must be contained in every clinical handover. Clinical areas may choose to utilise ISOBAR instead where the ‘O’ stands for Observation.



CHHS18/070

This data set must include the following (see Attachment 3 and 4): Introduction:

Use three unique identifiers (Name, DOB, URN or address) to identify the consumer, introduce yourself and the clinician taking over the consumer’s care

Situation:State the immediate clinical situation of the consumer and list the most important and recent observations including interpretation of observations

Background:Provide relevant background/history to the consumer's clinical situation; i.e. reason for admission and other health and risk factors including allergies and infection status

Assessment:Identify assessments, including risks and actions that need to occur; i.e. anticipated consults, test results, risk of falls, risk of deterioration, etc.

Recommendations/ Read back:Identify timeframes and requirements for handover of care. Read back is an opportunity for staff/consumer/carers to ask questions or comment. Ask receiver to repeat key information to ensure a shared understanding.

Phone Handover of ResultsWhen staff are receiving results over the phone ISBAR must be used (see attachment 6).

Medical Imaging For procedures around handover of results from Medical Imaging please refer to the Communication of urgent and unexpected findings – Medical Imaging Procedure.

PathologyAll handovers to or from pathology are required to comply with the Pathology Requests and Specimens Procedure and the Patient Identification – Pathology Specimen Labelling and the principles of handover.


Section 3 – Written Handover and Documentation

Documentation of Clinical InterventionsFor written handover ISOAP (Identification of those present including staff/consumer/others, subjective information, objective information, analysis/ action/ advice and plan) is recommended and should follow these principles: All clinical interventions must be documented and include any relevant information that

is likely to impact on the clinical care of the consumer. Clinical documentation should be completed at the time of intervention. If this is not

possible, documentation must be completed before the end of the shift in which the intervention occurred.

All clinical documentation should comply with the Clinical Record Management Procedure.



CHHS18/070

Documentation is to be organised according to the (I)SOAP tool headings (see attachment 6): o I: Intervention/Introduction

Identify yourself and give your reason for the clinical handover or interventions planned. Identify consumer using unique identifiers and others present such as carer, advocate or interpreter.

o S : subjective informationPresentation of the consumer’s viewpoint – their story, how they may feel

o O: objective information Objective observations of the consumer – factual, unbiased and measurable

o A: analysis/action/advice Analysis and interpretation of subjective and objective information followed by action implemented and any related advice or education provided

o P: plan Plan of care to incorporate any required changes to interventions and time frames – includes changes to care plans

Discharge SummariesAll discharge summaries should be completed within 48 hours of discharge as per the Discharge Summary Completion Procedure. When completing the discharge summary ensure that the consumer’s General Practitioner (GP) (or facility the consumer is being discharged to) is known, so that they may receive a copy. The consumer should be provided with a copy of the discharge summary at the time of discharge.

Outpatient Letters All outpatient letters should incorporate the principles of written handover using ISOAP and be compliant with the Transcription Framework.


Implementation

Notification regarding this procedure will occur via the ACT Health Intranet HUB and Deputy-Director General bulletin and ACT Health Executive meetings.

Clinical Handover processes will be included during orientation of all new clinical staff to ACT Health.

Techniques and tools for Clinical Handover are included in the following training and updates for clinical staff, including:o COMPASS training o Clinical Handover eLearning on Capabiliti o Clinical Records Documentation Requirements eLearning on Capabiliti


Related Policies, Procedures, Guidelines and Legislation



CHHS18/070

LegislationHealth Records (Privacy and Access) Act 1997Mental Health Act 2015Human Rights Act 2004Public Sector Management Act 1994Health Practitioner Regulation National Law (ACT) Act 2010Health Practitioner Regulation National Law Act 2009Health Practitioner Regulation National Law RegulationWork Health and Safety Act 2011Carers Recognition Act 2010

PoliciesPatient Identification and Procedure Matching PolicyConsumer Feedback Management in the Health Directorate PolicyACT Health Work Health and Safety Policy ACT Health Work Health and Safety Management System ACT Health Incident Management Policy

ProceduresConsumer Feedback Management in the Health Directorate ProcedureClinical Record Documentation ProcedureCommunication of urgent and unexpected findings – Medical Imaging ProcedureDischarge Summary Completion ProcedurePatient Identification and Procedure Matching ProcedureClinical Handover in MHJHADS ProcedurePathology Requests and Specimens ProcedurePatient Identification – Pathology Specimen Labelling

Standards and Guidelines Australian Commission on Safety and Quality in Healthcare National Safety and Quality Health Service Standards, 2017.Consumer Feedback Standards: Listening and LearningAustralian Guidelines for the Prevention and Control of Infection in Healthcare (2010)Australian Charter of Healthcare Rights




CHHS18/070

References

1. Australian Medical Association (AMA). (2006). Safe Handover Safe Patients – Guidance on Clinical Handover for Clinicians and Managers. Retrieved from: https://ama.com.au/sites/default/files/documents/Clinical_Handover_0.pdf

2. Australian Commission on Safety and Quality in Health Care (ACSQHC). (2010). the OSSIE Guide to Clinical Handover Improvement. Sydney, ACSQHC. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/ossie.pdf

3. National Safety and Quality in Health Service Standards, Australian Commission on Safety and Quality in Health Care. https://www.safetyandquality.gov.au/


Definition of Terms

ISBAR - introduction/situation, background, assessment, recommendation/read back)

IS(O)BAR - introduction/situation, observation, background, assessment, recommendation/read back)

ISOAP - Identification of reporter/consumer/others present, subjective information, objective information, analysis/ action/ advice and plan


Search Terms

Handover, Transfer of Care, ISBAR, IS(O)BAR, ISOAP, e-referral, referral


Attachments

Attachment 1: Situations for Clinical HandoverAttachment 2: Examples of CHHS handover formats to General Practitioners and Community

Services Attachment 3: ISBAR for Verbal HandoverAttachment 4: Example of ward handover sheet in ISBAR format Attachment 5: ISBAR for Telephone Handover Attachment 6: ISBAR example for receiving or providing clinical investigation results via

phoneAttachment 7:Example components of written documentation using ISOAP from the

Community Care Program



https://www.safetyandquality.gov.au/

https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/ossie.pdf

https://ama.com.au/sites/default/files/documents/Clinical_Handover_0.pdf

CHHS18/070

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 21/02/2018 Complete Review Jane Murkin, DDG, QGR CHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS15/069 Clinical Handover



CHHS18/070

Attachment 1: Situations for Clinical Handover

These guidelines are provided to assist staff in developing handover processes in specific clinical areas/situations, including WHY, WHAT, WHO, WHEN and HOW solutions should a handover occur.

WHYImplement standard key principles?

Provide the best consumer care by improving the transfer of clinical information, responsibility and accountability.

WHATClinical information is handed over?

Locally defined minimum data set that meets the key principles, ensuring the most important clinical information is handed over.**

WHOShould attend the handover?

Key participants in the handover process are identified and available to attend the clinical handover of their consumers.

WHENShould handover occur?

Escalation of deteriorating consumer

Consumer transfers to another ward

Shift to shift change over

Consumer transfers for a test or appointment

Consumer transfers to another facility

Multi-disciplinary team handover

Consumer transfers to/from the community

HOWShould handover be delivered?

Face to face + checklist

In the consumers presence (bedside handover)

Face to face verbal only

Checklist

In a common staff area

Telephone handover

Mobile electronic tools

Detailed transfer letter

Tape recording

Adapted from source: Implementation Toolkit: Standard Key Principles for Clinical Handover, NSW Department of Health 2009

14

Legend Recommended Options

Not Recommended

Should Never Occur



CHHS18/070

Attachment 2: Examples of CHHS handover formats to General Practitioners and Community Services

Handover formats from CHHS to GPClinical Portal (Electronic Discharge Summary) Birth Outcomes System (BOS) Maternity consumers for uncomplicated births only Day Surgery Patient Operation ReportEmergency Department Information System (EDIS) Discharge Letter MAJICeR Electronic Discharge Summary (inpatient) and Letter to the GP (community)Chest Pain Assessment and Discharge FormOutpatient letters (e.g. by Medical Officers, Allied Health, Nurse Practitioners, etc.)Plastics or Orthopaedic Registrar Review Clinic Summary Centre for Newborn Care Discharge SummaryElective Short Stay Cardiac Procedures Admission and Discharge



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Attachment 3: ISBAR for Verbal Handover

NB: O can be added for observations (e.g. ISOBAR)



CHHS18/070

Attachment 4: Example of ward handover sheet in ISBAR format Using ISBAR for Ward Handover Sheet

INTRODUCTION SITUATION/BACKGROUND ASSESSMENT & ACTIONS RECOMMENDATIONS

Bed/Room

No.

Name/URN/Consultant

Age Diagnosis (situation)Relevant medical history

(Background)

Diet OBS BSL IVT/IVABS

Mobility Drains/IDC

Plans/Recommendations(date)

Allied Health

AD/EDD



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Attachment 5: ISBAR for Telephone HandoverUsing ISBAR in a telephone handover from Nurse to Doctor regarding deteriorating consumer.

Example of how ISBAR can be adapted for different clinical situations.

Taken from Early Recognition of the Deteriorating Patient Program, ACT Health 2007.

NB: O can be added for observations (e.g. ISOBAR)



CHHS18/070

Attachment 6: ISBAR example for receiving or providing clinical investigation results via the phone

Introduction:Using the three unique identifiers (Name, URN and DOB) identify the consumer the results pertain to. Identify yourself and identify the caller who is providing the results over the phone.

Situation:Request the reasons for the results, as per the request form.

Background:Discuss relevant background.

Assessment:Identify if any results were urgent or unexpected.

Recommendations/ Read back:Read back is an opportunity for staff to ask questions or comment. Ask receiver to repeat key information to ensure a shared understanding.



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Attachment 7: Example components of written documentation using ISOAP from the Community Care Program

DOCUMENTING CLINICAL INTERVENTIONSI Introduction

Set the scene Identify yourself (name, designation, team, time and date) Who is present (carer, family, interpreter, student)? Where did the intervention take place (health centre, ward, home visit)? What type of intervention is it (referral, admission, review or routine

report)? S Subjective information

The consumer viewpoint What is the consumer’s story? How do they feel? What symptoms are described by the consumer (severity, location,

duration & frequency)? Does the consumer report past medical/social history which is relevant? Is relevant information provided by other people present? Use quotation marks or client states.

O Objective information Objective observations of the consumer – factual, unbiased and measurable

What do you see? What are the results of your examinations?

A Analysis/action/adviceAnalysis and interpretation of subjective and objective information

What is your clinical reasoning? Action implemented

What did you do? Advice or education provided

What did you tell the consumer? P Plan

Plan of care - What happens next? What interventions have you planned? What time frames have you set for review or recovery? Who have you corresponded with or referred to?



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